Application to Participate in Adventure Therapy Trek With Indiahikes

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Please take some time to fill out this form. It will help us understand why you want to be a part of the Adventure Therapy trek. Expect a call from us within 48 hours after you fill out this form.

All information shared on this sheet will remain confidential and will not be shared with anyone.

Your full name *

Your email id *

Your phone number *

Age *

Which city are you from?

Do you feel any of the following issues? Tick the boxes that you think reflects your present state *

Lack of confidence

Feeling low

Unable to focus on anything

Not seeing a hopeful future

Afraid to tackle difficult situations

Feeling overwhelmed

Other:

Required

Why do you want to be a part of the Adventure Therapy Trek? What issues are you facing? Answer in a paragraph or two. *

Are you currently undergoing therapy? *

Yes

Has a therapist referred this program to you?

What are your expectations from this Adventure Therapy trek?

Trekking in the Himalayas requires fitness (we want you to cover a distance of 5 km in 38 minutes). Do you think you will be able to reach this fitness criteria by the beginning of April?

Yes

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